Nahabedian Maurice Y
Department of Plastic Surgery, Georgetown University, Washington, District of Columbia.
J Surg Oncol. 2016 Jun;113(8):895-905. doi: 10.1002/jso.24210. Epub 2016 Feb 26.
Breast reconstruction using prosthetic devices is the most commonly performed procedure in women following mastectomy. The goal is to provide an outcome that is predictable and reproducible while minimizing complications and optimizing aesthetics. There are various strategies by which this can be achieved. It begins with proper patient selection because most adverse events occur in high-risk patients. This in turn is related to the timing of the reconstruction that can be performed immediately following the mastectomy or on a delayed basis. Many surgeons have been combining the use of acellular dermal matrices with prosthetic devices that require strict attention to detail to ensure success. There are various options for achieving device coverage that include total muscle, partial muscle, and subcutaneous coverage. The radiated patient poses additional challenges and limitations that must be understood to achieve a desired outcome. Finally, autologous fat grafting has become a valuable tool to improve outcomes in both radiated and non-radiated women. These factors will be reviewed with the intent of improving outcomes and minimizing complications in the setting of prosthetic breast reconstruction. J. Surg. Oncol. 2016;113:895-905. © 2016 Wiley Periodicals, Inc.
使用假体装置进行乳房重建是女性乳房切除术后最常施行的手术。目标是提供可预测且可重复的结果，同时将并发症降至最低并优化美观效果。实现这一目标有多种策略。首先要进行恰当的患者选择，因为大多数不良事件发生在高危患者身上。这又与重建的时机有关，重建可在乳房切除术后立即进行，也可延迟进行。许多外科医生将脱细胞真皮基质与假体装置联合使用，这需要严格关注细节以确保成功。实现假体覆盖有多种选择，包括全肌覆盖、部分肌覆盖和皮下覆盖。接受过放疗的患者会带来额外的挑战和限制，必须了解这些才能达到理想效果。最后，自体脂肪移植已成为改善放疗和未放疗女性手术效果的重要工具。将对这些因素进行综述，目的是在假体乳房重建中改善效果并减少并发症。《外科肿瘤学杂志》2016年；113:895 - 905。© 2016威利期刊公司
